Every life has a shape. Mine revealed itself slowly, not through titles or milestones, but through four songs that arrived at the right moments, each one naming a truth I had lived long before I had language for it. These songs are not nostalgia. They are architecture. They explain how I became the physician, the father, the steward, and the man I became. This is the overture to my career …
The cost of caring in medicine, told in four songs
In the 1970s, the American hospital was, in the industry’s own language, an “open workshop.” A physician kept an office down the street, admitted patients to the hospital when they needed a bed or an operating room, and worked largely independent of whoever managed the building. The doctor made the medical decisions; the administrator kept the lights on and the ledgers balanced. It was an arrangement with obvious flaws (fragmentation, …
The corporatization of medicine, in salaries and beds
George Orwell’s Animal Farm remains a powerful parable about how systems created with good intentions can gradually lose their way when power concentrates and accountability weakens. The animals overthrow an exploitative farmer with dreams of equality, only to see new leaders adopt the very behaviors they once opposed. Medical regulation offers a real-world parallel, not a complete betrayal, but a system that sometimes drifts from its original balance between patient …
Medical board reform starts with restorative justice
My daughter has a stuffed monkey named HaHaHa. He has been an important part of our family since she was about a year old. Before you make fun of his name, his name is HaHaHa because that is how a monkey talks. She takes his name very seriously and is not at all ashamed. He is, after all, her best friend. With a name like HaHaHa you cannot help but …
What a stuffed monkey taught me about comfort objects
For years now, the burnout conversation in health care has been almost exclusively fixated on mid-career physicians, who are staring down decades of EHR documentation and quietly refreshing their LinkedIn profiles. These exhausted doctors in their prime are considering early exits, career pivots, and anything to get out from under the weight of it all. However, there’s another story playing out, quieter and in some ways more striking, among physicians …
Why AI scribes keep senior physicians in practice
The death of NASCAR driver Kyle Busch, a relatively healthy 41-year-old, startled the public in late May when his severe pneumonia progressed into sepsis. While pneumonia is a common condition, Busch’s development of sepsis, when the body goes into organ failure after an infection, is highly unusual, as sepsis tends to affect patients who are either very young, very old, or have chronic medical conditions.
Despite being one of …
What Kyle Busch’s death reveals about sepsis
“Who is the best resident in your program?”
If you ask this question at a residency program faculty meeting, the answers are rarely about board scores. You’ll hear discussions about the resident who stays calm during a difficult airway. The junior resident who notices subtle clinical changes before anyone else does. The senior resident others trust at 2 a.m. when the attending is exhausted. The trainee who inspires confidence in both …
Standardized testing doesn’t measure the best doctors
He has been tired for eight months. Not the tiredness that follows a bad night of sleep, a hard week, or a season of stress. The kind that just does not lift. The kind that is still there after the weekend, after the vacation, after every reasonable explanation has been tried and discarded. He also has a cough that will not quit, something happening with his nails, unrelenting brain fog, …
Why complex chronic illness slips through the cracks
The chart is already open when my patient walks in. Forty-two years old, no significant medical history, last seen 18 months ago, not by me, but by a practice three miles down the road. I scroll through the treatment plan they sent her home with. Seven procedures and four of them major. A timeline that would have her back in a chair every six weeks for the next year. She …
How corporate dentistry changes what you’re told
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Clinicians are treated as invincible, so when their own mental health suffers, many stay silent. Namit Choksi, a physician entrepreneur and health care executive, joins to explain how credentialing forms and a culture …
How credentialing fears harm physician mental health [PODCAST]
An excerpt from From Starship to Sickbed: Star Trek and the Meaning of Medicine.
“The City on the Edge of Forever,” widely regarded as Star Trek: The Original Series at its best, unfolds not merely as a science fiction episode but as a meditation on time, love, and moral consequence. Drawn from a teleplay by Harlan Ellison, the story begins with a disturbance that is temporal, yes, …
Idealism vs. realism in medicine, and when to let go
Today, I am sitting in a lounge chair receiving an iron infusion while writing this article. For most people, an iron infusion is a routine medical treatment. For me, it represents something much larger. It represents years of adaptation.
For as long as I can remember, I have lived with iron deficiency anemia. It was never considered severe enough to warrant specialty treatment. The recommendations were familiar: take iron supplements, eat …
When physician burnout starts to feel like normal
Artificial intelligence is arriving in eldercare for a reason that receives far less attention than the technology itself. It is not entering because the technology has suddenly matured or because health care has embraced a new digital vision. It is entering because the workforce responsible for caring for older adults is approaching its practical limits.
The United States is entering a demographic transition unlike any it has experienced before. Millions of …
AI in eldercare is a workforce story, not a tech one
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The best investment I ever made didn’t start with a pitch deck. It started with a nurse spending two hours on a task that should have taken ten minutes.
I was rounding as a hospitalist, and I noticed, again, the amount of time clinical staff spent on manual equipment checks, compliance logs, and inventory reconciliation. It was the kind of operational friction that becomes invisible when you see it every day. …
Why health care investing should start at the bedside
A few months ago, I had just completed another demanding overnight shift. As morning approached, I finished my documentation, prepared to hand off my patients to the day team, and looked forward to driving home. Before leaving, our hospital administrator joined our morning huddle to thank both the day and night physicians for caring for patients around the clock. As our conversation came to an end, he smiled, looked at …
Supporting night shift workers starts with one question
Every single night in the ICU, I am shocked by the number of people who have never discussed with their family what they would want done if their heart stops beating. Whether they would want to be shocked out of a bad rhythm. Whether they would want CPR, chest compressions, bones broken in the process. What they would want if a catastrophic illness were going to take their life, or …
Why end-of-life conversations can’t wait for the ICU
During my residency, while rotating through the spinal cord unit at the VA Hospital in Puerto Rico, I cared for young veterans who, to my surprise, had, in most cases, adjusted remarkably well to a new reality: they would spend the rest of their lives in a wheelchair. I remember one case, in particular. I recollect this case well because the patient was the unofficial Don Juan of the unit. …
Depression after spinal cord injury hides in plain sight
A mother calls a neurologist’s office the morning after watching her daughter seize in her sleep. She calls as soon as the office opens, explains exactly what happened, and waits for guidance. The earliest appointment is three months away. That is not a worst-case scenario. It is routine.
This is what the child neurology shortage actually looks like. It does not arrive as a headline. It arrives as hold music. It …
The child neurologist shortage is a policy choice
Walk down any grocery aisle and you will see products covered in health claims: sugar-free, naturally sweetened, organic, gluten-free. For most shoppers, these labels are a minor annoyance. For a patient recovering from bariatric surgery, trusting the wrong one can mean an afternoon of dumping syndrome.
The term “bariatric-friendly” has no regulated definition. Any company can print it on a package. That leaves physicians, and eventually patients themselves, to figure out …
What bariatric-friendly food really means
One of the hardest questions in intellectual disability psychiatry that I have found myself grappling with over the past year as a registrar in the subspecialty is surprisingly simple: Is this person in pain?
Most people assume pain announces itself clearly. A broken bone hurts. A toothache hurts. An infection hurts. The body sounds an alarm and we respond. In practice, as I have encountered time and again, it is rarely …
Recognizing pain in autism when there are no words
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